In this resource, I’m going to outline the key things you can do to improve your chances of a frozen embryo transfer (whether euploid or otherwise).
Long Term Pre Transfer Cycle - Fertility Specialist & Naturopath Moderated Transfer ConcernsDiscuss these with your doctor 6-9 months prior to your planned transfer
Generally speaking your fertility specialist would raise these, but you’d be surprised at how often they do not. Each of these are known contributors to both implantation failure and miscarriage. Theoretically based on the below if you do all the diagnoses at the around the same time, you’re looking at 2-3 months needed prior to transfer so it’s important that you account for this potential time in your planning.
If any diagnoses come back positive, then you’re looking at 4-6 months from transfer.
⭐ 119 total percentage point increase available across all of the items in the table below—which is more than possible, but shows how if you address all these issues where you have them, you give yourself an excellent chance as a starting point.
| Concern | Usual Diagnosis and Treatment | Expected timing to fix | Impact | Research |
|---|---|---|---|---|
| Fibroids (even small ones) | Excision/removal. This can often be done via hysteroscopy at the time of an egg retrieval. | Within 4 weeks usually. Can potentially be done at the same time as the other checks below. | 43.3% clinical pregnancy rates for operated versus 27.2% for unoperated |
16 percentage point increase | Link |
| Endometriosis | The gold standard check for endo is a laparoscopy which requires general anaesthetic and x2 week recovery. Shouldn’t be done before more egg retrievals as it can impact FSH and antral follicle counts. | As this is a day surgery it usually takes 3 months to book in if it’s elective (not an emergency). | 41% clinical pregnancy rates for operated and removed vs 24% for unoperated (link)
17 percentage point increase | Link |
| Endometritis | A mock cycle is performed and then a biopsy of the endometrium is taken during the proliferation phase (basically post your ovulation if you do a natural mock cycle or post x5 days of progesterone if you do a medicated cycle). The test is called ALICE (part of the Emma / Alice test) and is sent to Igenomix for review).
The treatment is usually some form of antibiotics. | 4 weeks for the mock cycle + 3 weeks to receive results back + 2 weeks for treatment then ideally another mock cycle and biopsy to confirm successful treatment. So minimum x2 months timeline, if you don’t have it and x4 months if you do.
Cost’s about $1.7k AUD / $1.1k USD. Some countries, such as Canada, offer free biopsies, however these biopsies won’t tell you what specific antibiotics will be needed as treatment. However they can be relevant as a cheaper option (where available) for rebiopsy to confirm if the treatment was successful. | 60% live birth for treated vs 36% for non-treated.
24 percentage point increase | Link |
| Endometria microbiota | As above, a mock cycle is performed and a biopsy taken. This part of the test is called EMMA (part of the Emma / Alice test).
*Usually the Endometrial Receptivity Assay (ERA) is run at the same time. But there is consensus amongst many doctors now that the test is flawed, and that importantly, if you do end up positive for it and need extra days of progesterone, that you end up with a worse outcome than not having done so at all. You can read more on this here and here. | As above (done at the same time). | Decreased time to positive pregnancy once treated | Link | | Bacterial vaginosis or other vaginal bacterial concerns | Even alongside this, general vaginal probiotics may be helpful. Especially for recurrent implantation failure.
| Theoretically you can manage this yourself, but Ecocillin or other brands do require your fertility specialist to prescribe and I think this is a much better option than buying something like Vagibiom off Amazon because there isn’t any proper temperature control in storage nor during transport to you. Take as prescribed.
Otherwise, the specific brand used by the research study was Gynoflor (100 million cfu of lactobacillus acidophilus KS400 bacteria and 0.03 of estriol) taken daily for 6 days from the day that luteal phase support began.
| Miscarriage rates were halved in treated vs untreated women (and live birth rates therefore had a 17 percentage point difference) | Link |
| High NK (Natural Killer) Cells | This also requires an endometrial biopsy. It can be diagosed via blood as well but the gold standard is endometrial biopsy. Treatment is usually the Bondi Protocol which significantly improves outcomes for anyone who has a borderline or high NK cell diagnosis. See more on it here. It includes the use of 10mg prednisolone and Clexane or Fragmin injections from 1 day prior to transfer through to up to 20 weeks | This can and should be done at the same time as the Emma/Alice test but this part of the biopsy usually gets sent off locally for review - not to Igenomix. | 27 percentage point increase in clinical pregnancy rate | Link |
| Adenomyosis | Ultrasound and MRI - would usually be separate to the above. Often 3-6 months of Zoladex is given prior to transfer. Other surgical treatment gold standard discussed here (Ultrasound-guided percutaneous radiofrequency ablation combined with Leuprorelin Acetate). | Diagnosis within one month and the if positive 3-6 months of treatment prior to transfer. Otherwise it will significantly decrease chance of implantation and increase chance of miscarriage if implantation does occur (link). | In one large prospective study, 55 of 165 patients with adenomyosis became pregnant after surgery followed by 6-course GnRH treatment or surgery alone, with a clinical pregnancy rate of 77.5% (link) | Link |
| General uterine lining thickness | You can get a referral to imaging specialist by your fertility specialist. I personally think it’s a great idea to have one natural cycle where you go get a transvaginal ultrasound and check 5 days after you’ve confirmed your own ovulation to understand what your natural uterine lining thickness is. That way if you’re doing a natural cycle, you’ll have a good idea of whether you’ll need any assistance to thicken the lining.
Apart from things your fertility specialist might suggest such as doing a medicated cycle instead and using HRT with high dose estrogen, HBOT is a potential treatment which you can learn more about from this study. | Daily (medical grade) HBOT for at least 10 days during the proliferative phase | 35 percentage point increase in clinical pregnancy rate | Link |
Discuss these with a naturopath 5-6 months prior to your planned transfer
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*I won’t link to all the various studies related to different supplement deficiencies. Vitamin D is a well known one. The others are less specific and more about getting your own body to its best state of balance. However, if you want to go a lot deeper on supplements and approaching you can read this other article I’ve written previously:
[Stop taking pills for nothing April 23, 2025 ](<https://foresightdigital.notion.site/Stop-taking-pills-for-nothing-1de711f77ffd80d88387efbe79bdf600>)
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👉 Personal and Practical Approach:
Shorter Term Pre Transfer Cycle Fertility or Family Doctor/GP mediated